脊柱手術(shù)的麻醉ppt課件(編輯修改稿)
2025-02-01 17:40 本頁面
【文章內(nèi)容簡介】 和快速 確切和快速拮抗藥 溫柔喚醒 試驗過程中無痛 No recall 喚醒試驗 Wakeup test 麻醉基數(shù) : 吸入麻醉藥 咪唑安定 丙泊酚 瑞芬太尼 缺點 : 需要患者配合 插拔氣管導(dǎo)管 實踐 延長手術(shù)時間 不能評估感覺通路 喚醒試驗 Wakeup test SSEPs 1. The most mon neurophysiological method for monitoring the intraoperative spinal functional integrity 2. The stimulus applied to the peripheral N (tibial or ulnar) 3. The recording electrodes placed: cervical region, scalp, or epidural space during surgery 4. Baseline data obtained after skin incision 5. Responses are recorded intermittently during surgery 6. A reduction in the amplitude by 50% and an increase in the latency by 10% are considered significant. Typical tracing and L10 1. SSEPs provides an indirect way of monitoring adjacent motor pathways because more acute impairment affects function of many adjacent pathways, not just the posterior column. However, this cannot be guaranteed. 2. The blood supply of the corticospinal motor tracts differs from that of the dorsomedial sensory tracts. It is possible to have normal SSEPs recordings throughout surgery, but to have a paraplegic patient postoperatively. ? Satisfactory monitoring of early cortical SSEPs is possible with – MAC isoflurane, desflurane and sevoflurane. ? Nitrous oxide potentiates the depressant effect of volatile anesthetics ? Intravenous anesthetics generally affect SSEPs less than inhaled anesthetics ? Etomidate and ketamine increases cortical SSEP amplitude ? Clinically unimportant changes in SSEP latency and amplitude after the administration of opioids 麻醉藥和 SSEPs SSEPs 監(jiān)測意義 ? Eliminating N2O from the background anesthetic has been shown to improve cortical amplitude sufficiently to make monitoring more reliable ? SSEP la
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